External Cephalic Version Lacks Adverse Outcomes

Efforts to reposition a fetus in the breech position via external cephalic version (ECV) significantly improve the likelihood of a vaginal delivery, according to a new study.

Researchers at Northwestern University (NU; Chicago, IL, USA) conducted a retrospective cohort study of 4,117 women with singleton gestations in non-vertex presentation that delivered during a 10-year period (2006 to 2016). Women undergoing an ECV attempt at 37 weeks of gestation or greater were compared with those with non-vertex fetuses who did not undergo an ECV attempt. The primary outcome was a composite of perinatal morbidity and mortality. Secondary outcomes included neonatal intensive care unit (NICU) admission and neonatal anemia.

ECV was attempted in only about a third (30.7%) of the women, with 40.3% of the attempts resulting in successful repositioning of the fetus. For both the primary and secondary outcomes, there were no significant differences between those who did and did not receive an attempted ECV. The full composite of the primary outcome included stillbirth, neonatal death within 72 hours, Apgar score less than five at five minutes, umbilical artery pH less than 7.0, base deficit 12 mmol/L or greater, or neonatal therapeutic hypothermia.

Analysis revealed that among women who underwent attempted ECV, more were non-Hispanic white, multiparous, and had a lower mean body mass index (BMI) at time of delivery compared with those who did not have an ECV attempt. Importantly, among the 40% of women who had successful ECV, as many as 79% delivered vaginally, whereas among those who did not undergo an ECV attempt and continued to have non-vertex fetal presentation at time of delivery, fewer than one percent ultimately delivered vaginally. The study was published in the August 2018 issue of Obstetrics & Gynecology.

“An ECV attempt at term is not associated with increased perinatal morbidity or mortality, compared with expectant management. Although success can be difficult to predict reliably, an ECV attempt does result in a significantly reduced chance of cesarean delivery,” concluded lead author Moeun Son, MD, and colleagues. “As such, these data support the existing recommendations that an ECV attempt should be encouraged when fetal malpresentation exists at term.”

ECV is a manual procedure by which an attempt is made to turn a breech baby from a buttocks- or foot-first position to a head-first position in order to enable vaginal delivery. It is usually performed after about 37 gestational weeks, as breech presentation greatly decreases after that. To perform ECV, both hands are placed on the mother's abdomen around the baby, who is then moved up and away from the pelvis and gently turned in several steps from breech, to a sideways position, and finally to a head first presentation.

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